I have today off. I love a good day off.
Call on Friday was rough, but not nearly as brutal as the last one. We actually managed to evade four admissions, which was handy, because we had six. My new call senior is weird. Very nice. Very knowledgeable. Very religious. Like, Evangelical Catholic, doesn't swear, won't prescribe birth control, can't say "God damn" in front of her. She got very excited when I told her I was Greek Orthodox. I'm not really sure why, because the Orthodox church is, um, old and stoic, but nowhere near Evangelical. And I certainly neglected to mention that I've read the Quran and the Mahabharata and I think Wicca has some good ideas and if the Church wasn't so ingrained in my family and my culture and my damn DNA I'd probably be a Buddhist (but then again, I have this theory that Jesus would be, too). She's also very slow, and overly thorough, and insisted at the beginning of call that I should do all the admissions, even the Green team ones, but that not only did I have to do all the work, she would come in with me to do the interview, like I was some damn medical student that couldn't tie my own medical shoes. Which, I think she's more motivated by her OCD than her mistrust of my abilities, but it still is annoying. And she's really nice. And she did do the 2:30 admission by herself even though it was a Blue Team patient, and I went to bed. Which was lucky because I was about to fall over.
And then in the morning I tried to put an IUD in this patient of mine who needs one for host of reasons that have nothing to do with contraception (she has her tubes tied already). And so we wheeled her allllllllll the way over to the Women's hospital so we could use their procedure room (not a short drive), and tried and tried, but her os was stenotic and it just wouldn't work. I tried. My attending tried. We couldn't get her to dilate enough to get the tiny little uterine sound in (it's about the size of a US3 knitting needle), much less the Mirena introducer. It was very painful for her, and I felt really, really bad. Really bad. So I called gynecology, to see if they had any ideas. Here's an excerpt from our conversation:
Me: So, I have this patient that I'm trying to put a Mirena into because [long, technical description of patient's medical history]. And I couldn't insert it because her os is stenotic
Him (before I could really tell him why I was calling the consult in the first place): Okay, first of all, [long, technical description of why my thinking is wrong. A conversation ensues about why I want to do this in the first place involving a lot of circular logic and me repeating myself].
Me (finally): Okay, whatever, anyway we thought maybe you could offer some ideas about the next step here.
Him: Well, she's bleeding, right?
Me: She is.
Him (chuckling): Well, her os has to be patent, because stuff's getting out. Otherwise she'd have metrometria.
Me: Duh, you dumbass. I said stenotic, I never said it wasn't patent. Okay, fine. Clearly her os is still open, but it's smaller than a uterine sound, which means I can't get an IUD in.
Him: Well, something you could do to make this really easy is to ripen her cervix with some -
Me: I did that. Last night. She got 400mg of vaginal misoprostol.
Him: Oh. Well. Did you sound the uterus?
Me: Of course.
Him: Well what did you use?
Me: Um...a uterine sound?
Him: Oh. Well I always sound the uterus with an endometrial sampling pipelle. It's easier on the patients and you know, you can't create a false passage through the cervix. (My attending's response to that comment when I told him later: "What's he on? You can do that any time you start poking around the cervix. You can do that with a speculum." Not really, but, the point is it's crap)
Me: Okay, whatever. I used a sound.
Him: Well, did you have good visualization of the cervix?
Me: No, I started poking blindly in her vagina with a sharp object. Of course.
Him: Well, did you use a tenaculum?
Me: Of course.
Him: Well, did you pull traction on the -
Me: Of course I did. I used to be a gyne resident. I know how to do this.
Him: Well, if you know how to do this, do you really need a consult?
In other news, I've started knitting up the yarn I got in my yarn swap with Tiny Tyrant.
It's a local (to her) yarn company called Royal Hare, handpainted superwash merino, dk weight (appropriate, no?). The color is Mt. Tam Moss. It's lovely. I'm knitting it on size threes (in the picture, it's on my little tiny Addi dps, but I started it doing magic loop on my Addi Lace that's a little too long - I think it's a 40" cable - and the sock went back on the Lace about ten minutes after this picture. The dps lasted about three rows. They were just too poke-y). I'm using Sarah's basic toe-up pattern, with a broken (moss-stitch) rib on the instep/leg.
I'm debating whether or not I should take my sock to the department Super Bowl party I'm going to this afternoon. That's a lot of prime knitting time. But I'm not sure they know me well enough yet for me to pull out the knitting at this sort of function...
Ooh, do you know what I'm doing tomorrow, though? I'm going to Duke Law school to be a fake expert witness for their trial practice class. Should be a fun time.